Application Form for 2009 Korean Government Scholarship Program for Graduate Students

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Application Form for

2009 Korean Government Scholarship Program for Graduate Students

1. Type of Scholarship

□ Academic Institutions Undesignated

( ) Korean Government ( ) Cultural Agreement ( ) Korea Foundation ( ) (Adopted)

( ) Korean Language Specialist

□ Academic Institutions Designated

*[2-3] Choose one and mark in the appropriate box.

2. Desired Academic Program □ Master's degree course □ Doctor's degree course 3. Desired Field of Study

□ Humanities and Social Science □ Natural Science and Engineering □ Arts and Physical Education

4. Personal Information (Please TYPE or PRINT clearly. Use black ink only.)

Full Name

native language

Passport Number

Family Name First Name Middle Name

English

Color Photo 3×4 cm

성(Family Name) 이름(First Name) Middle Name

Nationality Date of Birth

Gender □ Male

□ Female Marital Status □ Single □ Married Place of Birth Native language /

Other Languages spoken

Hobby Blood type

Home

Address ※In English only

Phone + - -

Country Code / Area Code / Number

Fax + - -

E-mail

University attended Office worked or

Address ※In English only

Phone + - -

Fax + - -

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5. Education (from secondary school onwards) Dates attended

(yyyy/mm/dd) Name of Institution Location of Institution

No. of Years of attendance

Principal Subject taken

Diploma or Degree

awarded

∼

6. Work Experience Dates worked

(yyyy/mm) Name of Organisation Position held Address of Organisation Phone No. of Organisation

∼

7. Language Proficiency

Language Type of Test

(TOPIK/TOEFL, etc)

Test

Score Date of Test

Level Fluent Inter-

mediate Basic 한국어 (Korean)

English

8. Family Background

Relationship Name Date of Birth Occupation Address

9. Previous Scholarship Awarded in Korea

Title of Award Dates funded

(yyyy/mm/dd) Study Field &

Name of Institution awarding scholarship

from to from to

10. Previous Stay/Visits to Korea Period

(yyyy/mm/dd) Place Purpose Organization Concerned

from to from to

11. Referees

Full Name Position Organization Contact Information

Postal Address Phone No. Email

Date: . . (yyyy/mm/dd) Name: (Signature)

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Pledge

1. As a grantee of the Korean Government scholarship, I pledge:

(1) To abide by rules and regulations of the university/institute I enroll in Korea under the scholarship and to pursue my study/research to the best of my ability.

(2) To respect the law and order of Korea and not to participate in any forms of political activities (such as organizing or joining a political party, attending political meetings, publishing political articles and statements, organizing or participating in demonstrations of a political nature).

(3) To take responsibility for repaying any debts incurred in Korea

(4) Not to object to the designation by NIIED of the institution providing Korean language training.

(5) To abide by all terms and regulations set by NIIED with related to the scholarship.

2. If I am proved to have violated any of the above pledges, to have made a false statement in my application documents or to have failed to comply with academic standards or the rules of university or research institute I attend to, I shall accept the decision of NIIED, even though it may include the suspension or revocation of the scholarship.

Date: . . (yyyy/mm/dd)

Name (Signature)

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Instructions for Self-introduction Essay

Write an essay for self-introduction not exceeding 2 pages on an A4 size format, one-sided only, dated and signed. It is recommended to contain the following things and must be clearly typed or printed using black ink.

x Family Background: including place and date of birth, family members

x Education: name(s) of school(s) attended, date(s) of attendance and other relevant remarks

x Work Experiences: name(s) of organization(s), date(s) of employment, position(s), department(s), duty(duties), and other relevant remarks

x Awards: received in the field of study or research x Publications: monographs, articles, conference papers x Extracurricular Activities: including community services

x Skills: including languages and computer skills, indicate the level) x Personal Value

x Others

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Instructions for Study Plan

Write a study plan not exceeding 2 pages in Korean or English on an A4 size format, one-sided only, signed and dated. The study plan must be written either in Korean or English. Please refer to the sample format below and include your purpose and plans for future academic study or research. In particular, 'how you will utilize your knowledge acquired in Korea' must be written after discussion with the referees. It must be typed or printed clearly using black ink.

< Sample >

Name Date of Birth

Previous Major if there is Preferred academic

institution in Korea Preferred field of study 1)

2) Korean Language

Proficiency

□ Advanced

□ Intermediate

□ Basic

Date taken Type of Test Score English Language

Proficiency

□ Advanced

□ Intermediate

□ Basic

Date taken Type of Test Score

Purpose of Academic Study or Research pursued in Korea with Detailed Plan

Your plan of using your knowledge acquired in Korea when you return to your home country after completing your study in Korea

Contact Information

Address Phone Number

E-mail Date:

Name (Signature)

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Reference

To be completed by the applicant:

Full Name

(Last Name/M/First name) Preferred Institution in Korea

Preferred Study Field or Research

---

To be filled out by the referee:

Please provide your candid assessment of the above named applicant. Kindly fill out the present form and hand it to the applicant in a sealed envelope with your sign over the seal. You may attach additional sheets if necessary.

1. How long and in what capacity have you known the applicant?

2. What do you think the strengths and aptitude of the applicant are?

3. What do you think the applicant's weaknesses?

4. Do you think the applicant is able to study at a higher academic institution in Korea as s/he plans? How do you think s/he will be able to utilize his/her knowledge acquired in Korea in the future?

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5. Please provide us with any further comments on the applicant.

Referee's Information 1. Full Name (Last/First/Middle) 2. Organization

3. Position or Title 4. Address

5. Phone

Country code / Area code / Phone number

6. Fax

Country Code / Area Code / Fax Number

Date:

Name (Signature)

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Self Medical Assessment

Name :

Please provide accurate information for the following questions.

QUESTION Yes No Explanation

① When and for what reason did you last consult a physician? (Please explain)

② Have you had any serious ailment, injuries or diseases in the last five years? (If yes, please explain)

③ Have you been hospitalized in the last two years?

(If yes, please explain)

④ Have you ever been treated by a doctor for any mental, emotional, or anxiety disorder?

(If yes, please explain and attach a report from your doctor)

⑤ Have you ever been addicted to any substances?

⑥ Do you have any allergies? (If yes, please list them)

⑦ Are you taking any prescribed medication?

⑧ Are you on a special diet?

(If yes, please explain in detail)

⑨ Have you ever suffered from depression?

THE ANSWERS I HAVE GIVEN ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

IF MY ANSWERS CONTAIN ANY KIND OF FALSEHOOD, I WILL TAKE ANY LEGAL RESPONSIBILITY. .

.

DATE (mm/dd/yyyy) SIGNATURE OF THE APPLICANT

FIRST NAME MIDDLE (INITIAL) LAST NAME